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ST. LOUIS — Missouri clinics are asking a judge to block an emergency rule that is keeping them from providing medication abortions across the state.

State regulations require abortion clinics to submit a plan to the Department of Health and Senior Services that outlines how they’ll handle complications that medication abortion patients may experience.

No other health care procedure or medication — despite some having substantial risks — involves a requirement that a complication plan be submitted to state officials for approval.

Planned Parenthood Great Rivers along with Planned Parenthood Great Plains submitted their complication plans to DHSS in February. But a few weeks later, state health officials issued an ““ changing the complication plan requirements in order to protect Missourians from “health and safety risks created by abortion inducing drugs.�

The rule went into effect March 27, the same day state officials informed the Planned Parenthood affiliates that their complication plans were denied.

“When state officials move the goalposts on us time and time again, their intentions become clear: they will stop at nothing to block Missourians’ access to critical reproductive health care,� Great Rivers President Margot Riphagen said in a statement Monday.

The Planned Parenthood affiliates late Friday in Jackson County Circuit Court seeking to block the new emergency rule and also a state requirement for a type of additional insurance policy they argue is impossible to obtain.

The motion was filed in a case that is seeking to throw out decades of rules and regulations that the abortion providers say are now in violation of the state constitution, which Missourians voted to amend in November to include the right to an abortion.

“Missourians have demanded reproductive freedom, including access to medication abortion, and we won’t stand by while state agencies manipulate the system in bad faith,� Great Plains’ President Emily Wales stated.

DHSS officials did not respond to requests for comment about the court motion, why requirements for medication abortion complication plans were changed, or what expert guidelines were used to write the requirements.

What the state requires

The state’s emergency rule requires that the physician prescribing the medication abortion has a written agreement with an obstetrician or obstetrician group with hospital privileges who is on call around the clock to “personally treat� complications.

The full names of medication abortion providers must be listed, so any time a new provider is hired, a new complication plan must be submitted and approved.

For patients who live further than 25 miles from the abortion clinic, the emergency rule states that clinics must request a waiver if they are unable to obtain a written agreement with obstetricians, but the clinics still must contract with “another qualified physician or physician group� to be on call around the clock.

Medication abortion providers must also identify the patient’s obstetrician or primary care provider, or a nearby obstetrician if the patient doesn’t have one. The provider must give the patient a letter containing the patient’s medical history and prescribed medications, to give to the patient’s doctor or emergency room in the event of a complication. The letter must include information about the abortion drugs.

The rule also requires communication within certain time frames between the physicians and with the patient.

Attorneys for the Planned Parenthood affiliates argue that the regulations needlessly require expensive back-up doctors, writing individualized patient letters that may never be used and communication among doctors without patient consent.

The requirements “infringe on patient autonomy by requiring the prescribing physician to repeatedly attempt to contact and ‘fully brief’ the treating physician, regardless of whether the patient consents,� the motion states.

DHSS states in its emergency rule that the use of abortion-inducing drugs without a complication plan poses “an immediate danger to the public health, safety or welfare.�

Safe and effective

But according to the , medication abortion is a safe and highly effective method of pregnancy termination during the first trimester of pregnancy. When taken, medication abortion successfully terminates the pregnancy 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001%, .

Medication abortion involves taking two different drugs, mifepristone and misoprostol, up to 48 hours apart. Some states allow the drugs to be mailed and taken at home. In Missouri, the first drug would be taken at the clinic, and patients would be released with the rest.

The drugs cause heavy bleeding and cramping, potentially with large blood clots, similar to a heavy period or an early miscarriage.

In 2023, there were approximately 642,700 medication abortions in the U.S., accounting for 63% of all abortions in the health care system, .

Attorneys for the Planned Parenthood affiliates argue that the DHSS emergency rule is not consistent with clinical standards of care and unfairly discriminates against abortion patients.

“In essence, the Complication Plan Statute singles out medication with a safety profile similar to that of Tylenol, and does so only when those medications are used to provide abortion,� the motion states. “No other medication, including , requires a DHSS-approved complication plan because such approval is not required for patient health.�

Dr. Margaret Baum, interim chief medical officer for Great Rivers, says doctors have procedures they follow in case of complication for every service they provide. But this is the only situation where a plan’s requirements are developed and approved by the state.

“There is nothing in the published literature, in textbooks, in journals, in studies that support needing a plan of this detail or with these specific requirements,� Baum said. “I do not know where they came up with it.�